Saturday, October 1, 2016

Hospitalism

In the first book of The Shiva Trilogy by Amish Tripathi, The immortals of Meluha, a reason was given for the greatness of Meluha. Apparently, the greatest legacy of Lord Ram to the Meluhans was a system he created to make sure only merit determines a person's position and it has made Meluha the greatest nation in history. All children that are born in Meluha are compulsorily adopted by the empire. To ensure that this is done methodically, all pregnant women have to go to a great hospital city for delivery unaccompanied by anyone. Once the child is born, it is left behind and the mother travels back. The children are given common education and a comprehensive examination at 15 determines their trade. The children never learn the identity of their parents. Shiva says, 'The efficiency and fairness of this system is astounding.'

John Carey said, 'The aim of all utopias, to a greater or lesser extent, is to eliminate real people' and this 'astounding' system is another one in which humans don't figure.I will just look at one element of this 'greatest legacy of Lord Ram' - adoption of children by the empire. Is it a good idea to separate children from their parents? I read about a pediatric disease called hospitalism in Monkeyluv by Robert Sapolsky. It is now mostly a disease of the past but illustrates the problem involved in separating children from their parents.

In some parts of the US in the early part of the 20th century, a typical child hospitalized for more than 2 weeks would start to show signs of hospitalism which involved a listless wasting away despite adequate food intake. There was a weakening of muscles and loss of reflexes, and greatly increased risk of gastro-intestinal and lung infections. With the onset of hospitalism, mortality rates had gone up almost tenfold.

The guess was that with kids crammed in pediatric wards, something infectious would be contracted. But this explanation was at odds with a strange pattern in the statistics: kids seemed to be less likely to succumb to hospitalism in the poorer hospitals, the ones that couldn't afford the state-of-the-art mechanical isolation wards for the supposedly infected kids.

By 1942, enough research had been done on developmental psychology for the correct explanation to emerge. A New York University physician deemed it to have been caused by 'emotional deprivation'. It was caused by two ideas prevalent at the time - the belief that sterile, aseptic conditions have to be maintained at all costs and the belief among pediatricians that touching, holding and nurturing infants was sentimental maternal nonsense.

Parental guides at the time used to warn parents of the adverse effects of using a cradle, picking up a child that cried or handling the baby too often. If parents were being advised like this, one can imagine how a nurse or attendant will interact with a child in a ward full of them. By today's standards, this sort of child rearing would be considered cold and austere.

Sapolsky mentions some animal studies that have been done in this regard. When an infant rat is licked and groomed by its mother, the pup secretes growth hormones, which triggers cell division - mother's touch is essential for growth. Experiments have shown that when a mother rat does a lot of licking and grooming, many changes happen in the developing brain of the pup which have lifelong effects - fewer stress hormones secreted as an adult, better learning under duress, etc. He writes:

Similar themes have emerged from primate studies, beginning with the classic work of Harry Harlow, who showed that infant monkeys understood development better than did the average pediatrician battling hospitalism - given a choice, the monkeys preferred maternal touch to maternal nutrition. And it was not sheer tactile stimulation that was essential. Harlow dared to inject into the modern scientific literature the word love when discussing normal primate development and what was essential. And in humans, a disorder of dramatically, even fatally disrupted development due to emotional deprivation can be found in every endocrine textbook on growth. It is called psychosocial dwarfism.

During the first couple of years of life, that part of a baby's brain develops which allows it to maintain human relationships and regulate its emotions. These circuits are constantly reinforced by regular interaction with the mother. Children need to have these interactions many hundreds of times in their growing years for these areas to develop properly. In The Brain That Changes Itself, Norman Doidge writes:

During World War II, Rene Spitz studied infants reared by their own mothers in prison, comparing them with those reared in a foundling house, where one nurse was responsible for seven infants. The foundling infants stopped developing intellectually, were unable to control their emotions, and instead rocked back and forth, or made strange hand movements. They also entered 'turned-off' states and were indifferent to the world, unresponsive to people who tried to hold and comfort them.

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About Me

I am an Engineer/MBA forced into early retirement. In 1999, at the age of 32, I suffered a brain stem stroke which left me a quadriplegic without speech. This blog is mainly about my life after the stroke.